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Sugar substitutes (non-sugar sweeteners)
Consumption of diet rich in sucrose results in high caries activity. Replacing
sucrose with the alternatives called as a sugar substitutes can help in reducing the
caries activity. They are classified as bulk sweeteners (caloric) and intense
sweeteners (non-caloric).
1. Bulk sweeteners (caloric)
Many of the bulk sweeteners are sugar alcohol, and being chemically similar
to sugars, they have a similar caloric content to sucrose, the most commonly
known include sorbitol, mannitol and xylitol.
Because sorbitol and mannitol are less sweet as sucrose, there may be a
tendency to increase caloric intake with the use of these two substances.
While xylitol has the same sweetness as sucrose.
Bulk sweeteners have similar physical characteristics as sucrose, and
their substitution does not change the customary size and weight of a
product (add volume and sweeteners to a product).
One of the disadvantages of bulk sweeteners is that they only partially
absorbed in the small intestine and pass the colon where they may
induce osmotic diarrhea. Bulk sweeteners are therefore not
recommended for children under three years of age and care must be
taken with sugar free medicines containing bulk sweeteners, since high
intakes cause gastrointestinal disturbance.
A.
Sorbitol:
it is used extensively as a non-sugar sweeteners in confectionary, chewing
gum, liquid oral medicines and tooth pastes.
The negative heat of dissolution is used advantageously in mints, which
have pleasant cool taste.
It is a derivatives of glucose occurs naturally in such fruits as apples, pears
and peaches and in several vegetables.
It is not actively absorbed from the gastrointestinal tracts and is absorbed at
about one third of the rate of glucose absorption. This means that eating
food rich in sorbitol allow blood glucose level to remain above the fasting
level for a longer time than does eating food correspondingly rich in
Preventive Dentistry
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glucose. Thus eating sorbitol may delay the onset of hunger. For this
reason, sorbitol is an ingredient in some foods designed for use in weight
reducing diet, and has been used clinically as non-insulin stimulating
carbohydrate, so can be used in diabetic foods.
WHO recommends intake of sorbitol be limited to 150 mg/kg/day.
Sorbitol is less cariogenic than sucrose, as it is fermented slowly by plaque
organisms, and the rate is very much slower than that for glucose and
sucrose. So it is associated with reduced plaque accumulation.
Sorbitol and sorbitol-containing products are considered safe for teeth. The
oral micro flora may adapt to sorbitol, so that it loses its harm property for
teeth.
B. Mannitol:
It has only 50% of the sweetness of sugar. It is less popular than sorbitol,
partly because of its higher price. It is used in tooth paste, mouth rinses and
as a dusting agent in chewing gum. It have a very low glycemic index and
consequently it is very suitable for diabetics.
C. Xylitol:
it is derived from birch trees, corncobs and oats as well as from bananas. It
is the best nutritive sucrose substitute with respect to caries prevention.
Xylitol can be considered as non-cariogenic and anti-cariogenic that
prevent dental caries. It’s non-ferment ability in plaque and it’s saliva
stimulating effect may support this statement.
Xylitol may have an anti-microbial effect since the plaque accumulation
after xylitol consumption is reduced and there is a good evidence that the
ability of plaque to produce acids by metabolism of sugar reduced by
xylitol. This seems to be explained adequately by the decrease in S.
mutans in plaque exposed to xylitol and possibly, a decrease in plaque
quantity. Xylitol have ability to inhibit growth and metabolism of S.
mutans to the same degree as some antimicrobials.
Microbiological studies have shown clearly that plaque organism did not
adapt to metabolize xylitol.
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2.
Intense sweeteners (non-caloric)
The need for intense sweeteners is acute. An intense sweeteners should
permit caloric reduction without sacrificing palatability.
For primary preventive dentistry practices, a non-carious product that
could be used in oral medication, mouth rinses, tooth pastes and all forms
of candies is highly desirable.
They are chemically very heterogeneous group, and are not chemically
related to sugar.
They have an intense sweet taste and contain no energy (have a negligible
energy value, or too little to have any clinical importance.
They are hundreds to thousands of times sweeter than sucrose.
They are not metabolized to acids by the oral microorganisms and they
cannot cause dental caries. Thus, they are perfect as far as dental caries is
concerned. However, they have disadvantages in taste, stability, lack of
volume, although a sweeteners with a low physical weight is also highly
desirable for reducing the size of the product packages.
The most popular intense sweeteners are:
1. Saccharine:
is considered approximately 300 times sweeter than sucrose. Due to its
intense sweetness, the use of saccharine is only about 4% as costly as an
equivalent sweetness derived from sucrose; it is compatible with most
foods and drug ingredients.
It has a bitter taste in concentration over 0.1%, although the perception of
this varies between individuals.
Saccharine has been reported to inhibit bacterial growth and metabolism
but its caries inhibiting effect are small.
2. Aspartame:
It is a dipeptide consisting of aspartic acid and phenylalanine. It is
approximately 200 times sweeter than sucrose with a similar taste to sucrose. Loss
of sweetness in storage is the main disadvantages.
Individuals with phenylketonuria, who have a genetic defect of
phenylalanine metabolism, should avoid ingestion of aspartame.
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3. Acesulfame K:
It is approximately 200 times sweeter than sucrose. It has a pleasant sweet
taste. Its sweetness is quickly perceptible and diminishes gradually without any
unpleasant aftertaste. It is thought to have a good potential as a sweetener in most
classes of food and drinks and useful sweetener in boiled sweet and preserves.